The Waitangi Tribunal has found
the Government had no clear alternative plan for Māori
health when it scrapped Te Aka Whai Ora – the Māori Health
Authority.
The second part of the Hautupua: Te Aka
Whai Ora (Māori Health Authority) Priority Report was
released on Friday, and examined the Crown’s
process for developing plans to address Māori health in
place of a Māori health authority.
The Tribunal found
the Crown:
- failed to adequately inform Māori
about its alternative plans - failed to recognise and
respect tino rangatiratanga - failed to consult with
Māori and be sufficiently informed about key elements of
its plans - failed in its duty of active protection
and Māori’s right to self-determine what is best for Māori
health - failed to properly engage with Māori about
the Hauora Māori Strategy and Pae Ora Amendment
Act.
It found these breaches had caused, and
would continue to cause, short and long-term prejudice to
Māori and repeated its previous finding that the Crown had
shown “reckless disregard for the Crown-Māori
relationship”.
They recommend that a stand-alone
Māori health authority be revisited.
‘Significant
lag’ after Te Aka Whai Ora disestablished
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Te Aka Whai
Ora was scrapped as part of the Government’s 100-day
programme. The Pae
Ora (Disestablishment of the Māori Health Authority)
Amendment Bill was introduced under urgency in February
2024.
Then-Health Minister Dr Shane Reti said at the
time the Government wanted to pursue “a different dream” for
Māori health, with greater decision-making and care
delivered closer to home and hapū.
However, the
Tribunal said the Crown did not have a clear alternative
plan in place when that happened.
It said the Crown’s
failure to develop one resulted in a “significant lag”
between the disestablishment of Te Aka Whai Ora and an
alternative.
“For nearly 18 months the Crown
repeatedly informed claimants, the Tribunal, and the public
of its intention to develop alternative plans in lieu of Te
Aka Whai Ora, but these intentions did not materialise and
were not reflected in Crown action,” the Tribunal
said.
It found the delay was inconsistent with the
principles of kāwanatanga and good government.
“The
Crown failed during this period to take any meaningful
action towards Māori health equity or to provide an
alternative plan to Te Aka Whai Ora,” it said.
The
Tribunal found that inaction breached the principles of
equity, active protection and options.
‘No meaningful
consultation’
The Tribunal said there was no
meaningful consultation with Māori over key elements of
what the Crown eventually described as its alternative
plan.
“We see no evidence of meaningful engagement or
consultation between the Crown and its Tiriti / Treaty
partner,” the Tribunal said.
It said the Crown’s
approach had “in many ways” deteriorated since the first
stage of the inquiry.
The Tribunal found iwi-Māori
partnership boards were approached after decisions had
already been made. It described this as “more of a
box-ticking exercise than any form of meaningful engagement
with Māori”.
It said the purpose of consultation was
for the Crown to fully understand the impact of proposed
legislation, policies and actions on Māori rights and
interests.
“The Crown has failed to do that in this
instance,” it said.
The Tribunal found the Crown
failed to adequately inform Māori about its alternative
plans, saying it had told them the plans were forthcoming
before later confirming the plans were already in
place.
It found this breached the principle of good
government.
The Tribunal said the Crown failed to
properly engage with Māori about two key elements of the
alternative plan: the Hauora Māori Strategy and changes to
the Pae Ora Amendment Act.
‘Double standard’ over
health system reviews
The Tribunal also criticised
the Crown for what it described as a “double standard” in
how it reviewed changes to the health system.
It found
Te Aka Whai Ora was reviewed just 10 months after its
establishment, while the Government said other system-wide
changes in the health sector would need to operate for
longer than a year before being reviewed.
“The Crown
failed in its duty to follow its own laws, rules, and
standards,” the Tribunal said.
“This signals a double
standard and is a breach of the Tiriti / Treaty principle of
good government.”
It said a regulatory impact
statement for changes to the health system only partially
met quality assurance requirements because of limited
consultation. The Tribunal said this was despite its
previous recommendation that the Crown should undertake
proper regulatory impact analysis for matters affecting
Māori health.
What was the Government’s alternative
plan?
The Crown initially told the Tribunal an
alternative plan was being developed.
Over the course
of the inquiry, it pointed to a range of health system
settings and changes, including the roles of iwi-Māori
partnership boards, the Hauora Māori Advisory Committee,
the Ministry of Health and Health New Zealand.
It also
identified the Government Policy Statement on Health, the
New Zealand Health Plan and the Hauora Māori Strategy as
key elements.
The Tribunal assessed these existing
health system settings as the Crown’s alternative plan. But
it questioned whether those arrangements met the Crown’s
obligations as a Treaty partner.
Tribunal concerned
about shift away from Māori-specific health
policy
The Tribunal highlighted a Cabinet
circular issued in September 2024 directing agencies to
focus on “needs”, rather than ethnicity.
It said
the shift in language and policy approach was also reflected
in health targets which focused on the total population
rather than Māori-specific outcomes.
The Tribunal
said evidence presented during the inquiry showed that the
effects of this shift were “far from minimal”.
It said
a focus on the mainstream population ignored the particular
health characteristics and needs of Māori. A shift away
from Māori-specific approaches was a clear signal that “te
Tiriti is not central in relation to policy development,
service design or delivery,” the report
said.
Tribunal recommends revisiting standalone
authority
The Tribunal recommended that the
Crown:
- commits to revisiting the option of a
stand-alone Māori health authority - consults
extensively with Māori and make informed decisions on
matters concerning Māori health - bases all
decision-making concerning Māori health, particularly
measures addressing longstanding Māori inequities, on
robust evidence and scientific knowledge.
RNZ
has requested responses from Health Minister Simeon Brown
and Mental Health Minister Matt Doocey.
The former
chief medical officer for the Māori Health Authority said
the Government did not act in good faith when scrapping the
entity.
‘Real shame’
Dr Rawiri Jansen was a
key witness for the Waitangi Tribunal report into the
Crown’s alternative plans for Māori health. He told
Midday Report it was a “real shame” the Government
acted in that way.
“They said they were going to have
a plan, they didn’t do any work on a plan. They said they
had a plan, they did not have a plan… Never seen anything
like it.”
Jansen said before one health system would
work for all, inequities needed to be removed.
“Fix
all of that historic grievance and you can imagine having
one system, but in the absence of fixing it that’s not an
approach which we can rely on, and we don’t believe that
they are honest and truthful in asserting
it.”
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